Provider Demographics
NPI:1932858628
Name:BAY AREA PL SERVICES
Entity Type:Organization
Organization Name:BAY AREA PL SERVICES
Other - Org Name:BAYPLS - CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SALUSTIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIBEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-300-4436
Mailing Address - Street 1:841 SAN BRUNO AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3443
Mailing Address - Country:US
Mailing Address - Phone:415-300-4436
Mailing Address - Fax:415-367-1514
Practice Address - Street 1:841 SAN BRUNO AVE W STE 100
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3443
Practice Address - Country:US
Practice Address - Phone:415-300-4436
Practice Address - Fax:415-367-1514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY AREA PL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-21
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA524783Medicaid
CA05D2179598OtherCMS CLIA LAB